Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Epilepsia. 2010 Jul;51(7):1266-76. doi: 10.1111/j.1528-1167.2009.02487.x. Epub 2010 Feb 1.
Epilepsy surgery in young children with focal lesions offers a unique opportunity to study the impact of severe seizures on cognitive development during a period of maximal brain plasticity, if immediate control can be obtained. We studied 11 children with early refractory epilepsy (median onset, 7.5 months) due to focal lesion who were rendered seizure-free after surgery performed before the age of 6 years.
The children were followed prospectively for a median of 5 years with serial neuropsychological assessments correlated with electroencephalography (EEG) and surgery-related variables.
Short-term follow-up revealed rapid cognitive gains corresponding to cessation of intense and propagated epileptic activity [two with early catastrophic epilepsy; two with regression and continuous spike-waves during sleep (CSWS) or frontal seizures]; unchanged or slowed velocity of progress in six children (five with complex partial seizures and frontal or temporal cortical malformations). Longer-term follow-up showed stabilization of cognitive levels in the impaired range in most children and slow progress up to borderline level in two with initial gains.
Cessation of epileptic activity after early surgery can be followed by substantial cognitive gains, but not in all children. In the short term, lack of catch-up may be explained by loss of retained function in the removed epileptogenic area; in the longer term, by decreased intellectual potential of genetic origin, irreversible epileptic damage to neural networks supporting cognitive functions, or reorganization plasticity after early focal lesions. Cognitive recovery has to be considered as a "bonus," which can be predicted in some specific circumstances.
对于因局灶性病变而患有早期耐药性癫痫的幼儿进行癫痫手术，如果能够立即控制癫痫发作，那么在大脑可塑性最强的时期，这为研究严重癫痫发作对认知发展的影响提供了一个独特的机会。我们研究了 11 名因局灶性病变而导致早期难治性癫痫（中位发病年龄 7.5 个月）的儿童，他们在 6 岁之前接受了手术治疗，术后癫痫无发作。
对这些儿童进行了中位时间为 5 年的前瞻性随访，期间进行了多次神经心理学评估，并与脑电图（EEG）和手术相关变量相关联。
短期随访显示，与剧烈传播性癫痫活动停止相对应，认知能力迅速提高[2 例伴有早期灾难性癫痫；2 例伴有退行性癫痫和睡眠中持续棘波（CSWS）或额叶癫痫]；6 例儿童的进展速度不变或减慢（5 例伴有复杂部分性癫痫和额叶或颞叶皮质畸形）。长期随访显示，大多数儿童的认知水平稳定在受损范围内，2 例儿童在最初获得进展后进展缓慢，接近边缘水平。
早期手术后癫痫活动的停止可能会导致认知能力的显著提高，但并非所有儿童都如此。在短期内，缺乏追赶可能是由于切除的致痫区丧失了保留的功能；在长期内，可能是由于遗传起源的智力潜力降低、支持认知功能的神经网络的不可逆癫痫损伤，或早期局灶性病变后的重组可塑性。认知恢复被认为是一种“红利”，在某些特定情况下可以预测。
